Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant?
Anemia is common in patients with chronic kidney disease (CKD) and is mainly caused by insufficient production of erythropoietin from fibrotic kidney. Because anemia impairs quality of life and overall prognosis, recombinant human erythropoietin-related products (erythropoiesis-stimulating agents, E...
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| Format: | Article |
| Language: | English |
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The Korean Society of Nephrology
2023-01-01
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| Series: | Kidney Research and Clinical Practice |
| Subjects: | |
| Online Access: | http://krcp-ksn.org/upload/pdf/j-krcp-22-118.pdf |
| _version_ | 1827942552178786304 |
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| author | Yu-Hsiang Chou Szu-Yu Pan Shuei-Liong Lin |
| author_facet | Yu-Hsiang Chou Szu-Yu Pan Shuei-Liong Lin |
| author_sort | Yu-Hsiang Chou |
| collection | DOAJ |
| description | Anemia is common in patients with chronic kidney disease (CKD) and is mainly caused by insufficient production of erythropoietin from fibrotic kidney. Because anemia impairs quality of life and overall prognosis, recombinant human erythropoietin-related products (erythropoiesis-stimulating agents, ESAs) have been developed to increase hemoglobin level for decades. However, many safety concerns have been announced regarding the use of ESAs, including an increased occurrence of cardiovascular events, vascular access thrombosis, cancer progression, and recurrence. Hypoxia-inducible factor (HIF) is crucial to erythropoietin production, as a result, prolyl hydroxylase domain (PHD) enzyme inhibitors have been new therapeutic agents for the treatment of anemia in CKD. They can be administered orally, which is a preferred route for patients not undergoing hemodialysis. In clinical trials, PHD inhibitor could induce noninferior effect on erythropoiesis and improve functional iron deficiency compared with ESAs. Although no serious adverse events were reported, safety is still a concern because HIF stabilization induced by PHD inhibitor has pleotropic effects, such as angiogenesis, metabolic change, and cell survival, which might lead to unwanted deleterious effects, including fibrosis, inflammation, cardiovascular risk, and tumor growth. More molecular mechanisms of PHD inhibition and long-term clinical trials are needed to observe these pleotropic effects for the confirmation of safety and efficacy of PHD inhibitors. |
| first_indexed | 2024-03-13T09:59:51Z |
| format | Article |
| id | doaj.art-88e57e8f40c74ac98a62409627197467 |
| institution | Directory Open Access Journal |
| issn | 2211-9132 2211-9140 |
| language | English |
| last_indexed | 2024-03-13T09:59:51Z |
| publishDate | 2023-01-01 |
| publisher | The Korean Society of Nephrology |
| record_format | Article |
| series | Kidney Research and Clinical Practice |
| spelling | doaj.art-88e57e8f40c74ac98a624096271974672023-05-23T06:12:37ZengThe Korean Society of NephrologyKidney Research and Clinical Practice2211-91322211-91402023-01-01421273810.23876/j.krcp.22.1186183Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant?Yu-Hsiang Chou0Szu-Yu Pan1Shuei-Liong Lin2 Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanAnemia is common in patients with chronic kidney disease (CKD) and is mainly caused by insufficient production of erythropoietin from fibrotic kidney. Because anemia impairs quality of life and overall prognosis, recombinant human erythropoietin-related products (erythropoiesis-stimulating agents, ESAs) have been developed to increase hemoglobin level for decades. However, many safety concerns have been announced regarding the use of ESAs, including an increased occurrence of cardiovascular events, vascular access thrombosis, cancer progression, and recurrence. Hypoxia-inducible factor (HIF) is crucial to erythropoietin production, as a result, prolyl hydroxylase domain (PHD) enzyme inhibitors have been new therapeutic agents for the treatment of anemia in CKD. They can be administered orally, which is a preferred route for patients not undergoing hemodialysis. In clinical trials, PHD inhibitor could induce noninferior effect on erythropoiesis and improve functional iron deficiency compared with ESAs. Although no serious adverse events were reported, safety is still a concern because HIF stabilization induced by PHD inhibitor has pleotropic effects, such as angiogenesis, metabolic change, and cell survival, which might lead to unwanted deleterious effects, including fibrosis, inflammation, cardiovascular risk, and tumor growth. More molecular mechanisms of PHD inhibition and long-term clinical trials are needed to observe these pleotropic effects for the confirmation of safety and efficacy of PHD inhibitors.http://krcp-ksn.org/upload/pdf/j-krcp-22-118.pdfanemiachronic renal insufficiencyerythropoietinhypoxia-inducible factor |
| spellingShingle | Yu-Hsiang Chou Szu-Yu Pan Shuei-Liong Lin Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant? Kidney Research and Clinical Practice anemia chronic renal insufficiency erythropoietin hypoxia-inducible factor |
| title | Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant? |
| title_full | Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant? |
| title_fullStr | Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant? |
| title_full_unstemmed | Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant? |
| title_short | Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant? |
| title_sort | pleotropic effects of hypoxia inducible factor prolyl hydroxylase domain inhibitors are they clinically relevant |
| topic | anemia chronic renal insufficiency erythropoietin hypoxia-inducible factor |
| url | http://krcp-ksn.org/upload/pdf/j-krcp-22-118.pdf |
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